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Implementing a Ventilator Bundle in a Community Hospital

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Background: Mercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU).

Methods: The two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol.

Results: Overall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1,000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1,000 ventilator days.

Discussion: The all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy.

Conclusion: The decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.

Document Type: Research Article

Publication date: April 1, 2007

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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